On Monday, January 27th, the United States Office of Management and Budget sent out an unprecedented directive instructing all government agencies to carry out a sweeping freeze on trillions of dollars in federal grants, loans, and other financial-assistance programs. This “temporary pause” would provide the Trump Administration “time to review agency programs and determine the best uses of the funding.” And the halt on payments was to begin the next day—Tuesday, January 28th—at 5 P.M.
The announcement provoked widespread confusion and disbelief. In a massive grab for power from Congress, the order seemed to halt almost every federal program touching people’s lives except Social Security and Medicare. O.M.B. identified twenty-six hundred programs affected. These include grants for law-enforcement and homeland-security activities; community health centers; firefighting; clinical trials across the country; special-education programs; and Meals on Wheels for the elderly. Even the portal for payments to states for Medicaid, which the Administration promised would be unaffected, shut down. Minutes before the 5 P.M. deadline, a federal judge blocked implementation of the freeze until she could review a challenge from multiple plaintiffs. Then today, O.M.B. rescinded its order. The legality of the plan was as murky as the intentions.
A week before the announcement, however, we received a clear indication of what was in store. On January 20th, amid the barrage of executive orders that Trump signed after the Inauguration—including the U.S. withdrawal from the World Health Organization—was an order to pause new foreign-aid spending commitments for ninety days. Soon afterward, the new Secretary of State, Marco Rubio, issued a stop-work order for the State Department and the U.S. Agency for International Development, halting not only new awards but virtually all existing programs.
Foreign aid has long been funded by bipartisan majorities in Congress as a cornerstone of national security, along with diplomacy and defense. This supports work, much of it through contractors and nongovernmental organizations, with countries worldwide in areas of mutual interest. Examples include combatting global disease threats and malnutrition; stopping human trafficking and drug trafficking; advancing access to education for girls; and demining postwar countries like Vietnam and Cambodia. In the days that followed, nonetheless, organizations across the U.S. and the world received letters stating that they must stop all work and use of existing funds immediately. No staff can be paid. No services can be provided. No medicines or supplies sitting on shelves can be used.
“To be clear, there is no such thing as a temporary pause,” Michael Schiffer, a former U.S.A.I.D. official, has written. “When an NGO, a small business, or an American company that receives U.S. government funding to implement U.S. foreign assistance is told to stop work, even for 90 days, that means people are fired, expertise is lost, and programs are shut down with no guarantee they’ll start back up, even if they survive the review.”
On the afternoon of January 27th, major portions of the staff who operate U.S.A.I.D. were purged. The top layers of civilian and foreign-service leadership—fifty-seven people in all, including the agency’s general counsel and ethics counsel—had their badges turned off and were put on immediate leave. Technical experts and support staff hired through contractors—which includes half of U.S.A.I.D.’s Global Health workforce—were dismissed. Orders instructed the remaining staff that they not only had to stop funding work with partner organizations but they also had to stop communicating with them. There could be no coördination or information exchange, whether with the World Health Organization or local universities and nonprofits. The U.S. Centers for Disease Control was put under a similar gag order.
The impact has been calamitous. I know the effect on health programs vividly, having run U.S.A.I.D.’s Bureau for Global Health during the last Administration. For example, the U.S. has limited sight on infectious-disease outbreaks in many parts of the world, such as Russia and China. So U.S.A.I.D. has funded experts in neighboring countries, such as Kazakhstan, sitting between those particular two, to upgrade monitoring and share information on bird flu and other deadly diseases. That work has halted.
Many other programs are similarly affected. U.S.A.I.D.’s work with W.H.O. and the government of Tanzania battling a Marburg virus outbreak—a cousin of Ebola with no approved test, drug, or vaccine, and a death rate of up to ninety-per-cent-death—halted.
The U.S. government’s work with countries around the world,W.H.O., and UNICEF, to eradicate polio—halted.
U.S.A.I.D.’s coördination and delivery of more than a billion dollars in corporate drug donations, which have brought neglected tropical diseases such as river blindness and elephantiasis to the brink of elimination in whole regions of the world—halted.
The deployment of medicines, supplies, staff training, and systems aiding more than twenty-five countries to increase access to vaccinations, prenatal care, safe childbirth, contraception, and other lifesaving health services for ninety-two million women and children—a program that has dramatically reduced death rates—halted.
America’s celebrated global H.I.V. program, PEPFAR—halted entirely. This includes its H.I.V.-vaccine research trials; its delivery of low-cost daily medications, which are keeping twenty million people with H.I.V. alive in more than fifty countries; and the rollout of a new U.S. drug that could end the AIDS epidemic —an H.I.V. treatment-and-prevention drug called lenacapavir, which delivers six months of protection in a single shot.
The effects go well beyond health. U.S.A.I.D. comprises the largest non-military operational capacity the U.S. has for assisting countries in many other areas of mutual coöperation. The agency has built a network of hundreds of thousands of personnel across the U.S. and the world, and it is supported to do this work mainly through federal grants and contracts. This infrastructure is the engine of American soft power. And in a matter of days—and contravening laws and budgets passed by Congress—the Trump Administration has attempted not simply to redirect U.S.A.I.D.’s policy but to gut the agency’s capacity.
This is not a pause. It is a destruction. And it’s all completely irrelevant to doing a “review.” Every Administration takes a top-to-bottom review of policy and spending and makes changes—even big changes, shifting the activities of whole agencies. But they act through constitutionally defined processes to make these happen—and work to protect people and institutions from harm. By both shutting down most of U.S.A.I.D.’s existing activities and purging the people who manage them, Donald Trump and his allies are eviscerating the entire structure.
Under public scrutiny and mounting pressure from Congress, Secretary Rubio did not rescind the foreign aid funding freeze, but instead only issued a waiver backtracking on parts of it, including on some of the global health programs. “Existing life-saving global health assistance programs for H.I.V., malaria, TB control, nutrition, skilled birth and prenatal care, and immunization should continue or resume work if they have stopped,” the waiver says. However, it’s unclear how narrowly “life-saving” will be defined. The resumption is temporary. (How long is not specified.) Work combatting new disease outbreaks, eradicating diseases such as polio, and supporting contraception seems to be excluded from the waiver. Plus, the demolition of staffing already turns the agency into a shadow of itself.
For a century now, the U.S. has led the world on collaboration and impact in health, which has doubled the life expectancy of all of humanity—and delivered similarly outsized results beyond health. If this Administration really wanted to put America first, it would have built on that legacy. Instead, it is demolishing U.S. standing, our world-leading capacity and expertise, and our national security.
The Administration has seemed intent on deploying this playbook across the entire scope of federal agencies and activities for the United States. There are other institutions driving whole areas of critical work—environmental protection, education, labor, and disease control, to name just a few—that the President has targeted for dismantling, despite the fact that both red and blue majorities in Congress have voted to fund them. Foreign aid is a speck in the 6.75-trillion-dollar government budget. At about eight billion dollars last year, U.S.A.I.D.’s global health budget is smaller than that of many hospital systems. But the agency’s experience reveals what remains at stake—the collective capacity of the American government to pursue the common good. ♦
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